Abdominal Flashcards
Describe visceral pain vs. parietal pain
Visceral: organ stretching, not localized
Parietal: Inflammation in the parietal peritoneum, LOCALIZED, aggravated by movement or coughing
What is referred pain? Where does
1) duodenal and pancreatic pain refer to?
2) biliary tree refer to?
Originates within the abdomen but is felt at distant
sites which are innervated at approximately the same spinal levels as the disordered structure
1) back
2) Right shoulder
What are the most important components of oldcarts for an abdominal exam?
LOCATION
Aggravating/Alleviating factors
Focused ROS you should probably ask about?
• GI: nausea, vomiting, diarrhea, black stools, blood in
the stool, blood in the vomit
• GU: dysuria, polyuria, hematuria, flank or CVA pain
GYN: vaginal bleeding, vaginal discharge, LMP, possibility of pregnancy
What other parts of the history are important?
Past surgical history
Current medicines: blood thinners, Narcotics, GI prescriptions, social history (esp. weed), family history
What is the order of the physical abdominal exam?
- Inspection 2. Auscultation 3. Percussion 4. Palpation
What is in the RUQ
Liver, gallbladder, stomach, SB, LB
What is in the RLQ
Appendix, ovary, SB, LB
What is in the LUQ
Stomach, Spleen,, SB, LB
What is in the LLQ
Colon, ovary, SB, LB
What is in the epigastric area?
Pancreas, Liver, gallbladder, stomach, SB, LB
What are you listening for with bowel sounds? What is abnormal?
bell to listen for bruits, 5-34 ‘clicks’/minute
absent sounds (non for 2 minutes): Long-lasting intestinal obstruction, intestinal perforation, mesenteric
ischemia
decreased sounds (none for 1 minute) Post-surgical ileus, peritonitis
increased sounds: Diarrhea, early bowel obstruction
What are high pitched bowel sounds indicative of?
sounds like tinkling (raindrops on metal)
early intestinal obstruction
What does percussion sound like in an abdominal exam? What is an abnormal sound?
Tympany predominates: gas in the GI tract, scattered areas of dullness is normal from fluid and feces
Abnormal: Large dull areas from a mass or enlarged organ OR Protuberant abdomen typanitic throughout may indicate an intestinal obstruction
Describe the organ assessment of the liver? What does it increase vertically? what does it decrease vertically?
– Right midclavicular line, start in RLQ (area of tympany) and percuss cephalad to an area
of dullness= lower border of liver – Right midclavicular line, start in RUQ (area of lung resonance) and percuss caudad toward liver dullness = superior border of liver
– Normal liver vertical span= 6-12 cm
– Vertical span increased with: • Enlarged liver= cirrhosis, lymphoma, hepatitis, right-sided heart failure, amyloidosis, hemachromatosis, Right pleural effusion (falsely increased)
– Vertical span decreased with:
• Shrunken liver = cirrhosis
Describe the organ assessment of the spleen? What does dullness indicate?
– Starting from border of cardiac border of left anterior axillary line, percuss laterally
– If tympany is prominent laterally in midaxillary line, splenomegaly not likely
– Dullness at midaxillary line= splenomegaly
When might you feel the spleen?
normal to feel in 5% of adults
low diaphragm in COPD PTs
Splenomegaly (HPT), mononucleosis
What is a shifting dullness test?
• Percuss the borders of tympany and dullness with patient supine • Then have patient lay on side and percuss borders again
Normal= borders stay the same
Ascites/ positive test= dullness shifts to dependent side and tympany to top side
What is a fluid wave test?
• Test for a fluid wave
• Ask the patient to rest his or her
hands over chest • Have an assistant place the ulnar
aspects of hands midline, then tapone flank sharply with finger tips • Normal= no impulse felt on the other
flank • Ascites/positive test= impulse
transmitted to the other flank
What is teh McBurney’s point tenderness?
draw an imaginary line from ASIS to umbilicus, and palpate
2 inches medial to ASIS on that line • Positive test= tenderness = APPENDICITIS
What is rovsing’s sign
- palpate deeply in LLQ
* Positive test= pain felt in RLQ = APPENDICITIS
What is Murphy’s sign? What is it for?
with right hand, palpate deeply under the patient’s right
costal margin, ask the patient to take a deep breath in, and palpate deeper
• Positive test= sharp increase in tenderness with sudden
stop in inspiratory effort = BILIARY COLIC, cholethilthis
What is Lloyd’s sign? / punch?
Pain to deep percussion in the area of the costovertebral angle. Positive test= pain in the area of the CVA with deep percussion = Pyelonephritis, ureterolithiasis
What is guarding? Voluntary vs involuntary
- Voluntary – patient consciously protects the abdomen when it is palpated
- Involuntary – unconscious contraction of the abdominal wall musculature when abdomen is palpated